Somebody's Going Home In The Back Of An Ambulance
by PolemicAcademic
Summary: My reading of how the CasualtyXHolby crossover 2019 might go down for the ED. AKA: Iain gets hurt. Badly.
1. Chapter 1

The blast was deafening. Picked up like a matchstick by the shockwave, he was hurled through the air and slammed against the perimeter wall. Struggling to his feet in the direction of the fire service guys (not that he could tell where anything was), he swayed for a minute. The smoke from the burning fuel rolled over him, burning, thick and sooty. Dragged the breath from his lungs, the water from his eyes.

He blinked, grittily, noticing a flash of red in his peripheral vision. Took a step, then plunged into the darkness.

* * *

It was Jan who noticed first.

The explosion from the crash site had caught them all off guard, and a thought struck her: Iain had been stabilising Bekka with Ruby, who had come to get some kit from the PO car...through the safety cordon.

She barely had time to register horror when, out of the corner of her eye, two firemen ran up, a long streak of green hanging limp between them.

_Iain._

"Right, get him on here, get his helmet off. Iain?"

Ruby's stricken face hovered at his other side.

"Iain? It's Ruby. Can you hear me?"

His breathing sounded terrible, rasping in his chest like he was breathing sand, accessory muscles heaving with the effort.

And no wonder. When she looked down his throat, it had almost swollen shut, scalded by the rolling tide of thick black smoke.

Dylan was at her side, the third person to notice.

"Severe burns to the upper airway, throat's swelling shut."

"Sats are 89 and dropping!"

"Right, he needs a surgical airway. Ruby, can you get me the kit please?"

Ruby ran, pulled the purple bag from the back of the car, and sprinted back.

Jan tilted Iain's head back, exposing the smudged white of his throat. Dylan traced the scalpel in a tight circle with practiced ease, cutting through the skin and muscle to open the windpipe. He slid the tube in, Ruby quickly taping it in place.

Almost immediately, Iain's chest rose, gasping in a massive breath.

The relief was short-lived.

The immediate threat taken care of, they started a primary survey which revealed what looked like a depressed skull fracture above his left ear, a fractured left collarbone, multiple broken ribs and what Dylan muttered tersely was "probably a nasty laceration to the spleen". Cutting away his uniform exposed livid purple bruising stretching down his entire left side, and what looked suspiciously like a bullet scar, stark and granular over his left hip. Grazes crisscrossed his palms.

_So he'd been thrown by the blast, dazed, forced himself to get up and move..._

These army boys. Never had known the meaning of the word 'stop'.

Then again, it was often easier to keep a cool head on a ship.

Despite his shock (and hers), she managed to get a line in and push the fluids, Dylan nodding with something approaching approval. As they wrapped him up, heading into the ambo, Iain's eyes began to flicker open in the bright light.


	2. Chapter 2

In my headcanon, Jan is ex-Navy. I meet a lot of military and ex-military people, and the Navy medics I know are some of the calmest, most chilled-out people on the planet. I mean, it's not as though you have anywhere to go and freak out if you're stationed on a ship. There might be a fic about Jan's backstory in the works soon if I can muster the brainpower.

Metaclopromide is an anti-sickness drug sometimes given to people who have to be secured on a spinal board (I can imagine it would be hard to log-roll someone so they can be sick in the back of a moving ambo, let alone with only one medic). Reviews would be awesome-if you came to me via Sherlock fanfic, you'll know I haven't written anything in about five years, so imma need feedback, I think.

* * *

Iain whimpered, the agonising pain of his broken ribs breaking his composure. As Ruby slid her hand into his, his mouth set into a firm line, breath panting through his nose in short, sharp bursts.

Dylan, always observant, noticed this. "Iain, I'm going to give you some ketamine for the pain. You need to be able to breathe properly or you're going to tire, alright?"

Iain nodded minutely, squeezing hard on Ruby's fingers and letting out a brittle cry as they hit a bump in the road.

Jan turned in the driver's seat, saying that they were nearly there, as Dylan pushed the painkiller in.

Iain's eyes flickered shut again as the drug took hold, and the ambulance sped along the motorway. Dylan had radioed ahead, and Ruby kept a close eye on his vitals, eyes flicking from monitor to face and back again.

They pulled in to the ambulance bay, moving quickly to get the trolley down to the tarmac.

Connie stood waiting at the door of the ED, alongside Rash, Robyn and David. Noel peered anxiously over from the desk.

"This is Iain, 35, thrown approximately ten feet by an explosion. Burns and oedema to the upper airway, surgical airway put in at scene. He's got a depressed skull fracture to the left hand side, broken clavicle and multiple broken ribs both on the left, and query internal bleeding. Sats are 93, pulse is 98, BP's 110 over 66 and he's had five of morphine, five of ketamine and ten of metoclopramide. GCS was 5, came up to 13 en route, now 11."

Connie nodded, face the tiniest bit shadowed.

"Right, bed number three please."

Dylan stood at the head of the trolley, watching the trach carefully for signs of movement.

"Everyone got a bit? Over on my count, _gently _please. One, two, three."

They set him on the bed smoothly, David doing his best to rouse him as they unwrapped the blankets from the scoop.

"Iain? Iain, open your eyes for me. You're in the ED."

Sluggishly, they opened, green eyes blinking owlishly up at the ceiling, and David could _see_ him trying to catch up. Iain was dazed, clammy as he squeezed his fingers. He let out a hoarse, strangled yell as Connie palpated his ribs. Robyn pinched his thumbnail between thumb and forefinger to gauge his pain response, and he slowly pushed back against her hands with a low moan.

"Responding to pain, responding to commands but incoherent sounds, current GCS of 11."

"Right, I want a full trauma set, chest, c-spine, and an abdo ultrasound and bleep the neurosurgeons please. FBCs, U&Es, ABG and crossmatch two units. Rash, watch out for respiratory acidosis and keep an eye on his lactate..."

_He'd heard it so many times before. Wasn't even sure who they were talking about, to be honest. Everything was sort of...vague. He let the words wash over him, the ache in his head shaking the thoughts loose. His train of thought skittered away, and he just wanted to go to sleep, but David kept squeezing his hands...  
_

_"Flail chest..."_

_"Intracranial bleed..."_

_"Laceration to the spleen..."_

_"Cardiac tamponade..."_

_"Decompensating..."_

_"BP's dropping!"_

_"He's bleeding from somewhere, get me the fast scanner and put the CT up..."_

_"There." _

Dylan's voice, ringing clear. _"Small laceration to the liver and another big one on the back of the spleen. Must've been pushed against the ribs. Lots of free fluid. Little bit in the pericardium."_

_"Bl..p...surg...get him...theat..re...BP...acidotic...numbers..."_

_David's hands were back, gently resting on his wrist, and he focused on them as the lift doors pinged and finally he could sleep._


End file.
